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Inspection on 22/08/08 for Haddon (52A)
Also see our care home review for Haddon (52A) for more information
This inspection was carried out on 22nd August 2008.
CSCI found this care home to be providing an Good service.
The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.
What follows are excerpts from this inspection report. For more information read the full report on the next tab.
Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.
Inspecting for better lives Key inspection report
Care homes for adults (18-65 years)
Name: Address: Haddon (52A) 52A Haddon Great Holm Milton Keynes Bucks MK8 9HP The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Barbara Mulligan Date: 2 2 0 8 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area
Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: ï· Put the people who use social care first ï· Improve services and stamp out bad practice ï· Be an expert voice on social care ï· Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information
Document Purpose Author Inspection report CSCI
Page 2 of 31 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home
Name of care home: Address: Haddon (52A) 52A Haddon Great Holm Milton Keynes Bucks MK8 9HP 01908262585 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): reception@macintyre.org MacIntyre Care Name of registered manager (if applicable) Elaine Forbes Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 15 0 care home 15 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD The maximum number of service users who can be accommodated is: 15 Date of last inspection 2 1 0 8 2 0 0 7 Care Homes for Adults (18-65 years) Page 4 of 31 A bit about the care home Set on the edge of Great Holm, 52A Haddon, owned by Macintyre Care, is located within a campus style complex, in amongst private housing. It provides accommodation to adults with learning disabilities. 52A Haddon is situated within walking distance of the local shops, church and local pubs. The building itself contains five self contained flats and a small garden area. There is a further complex of buildings that comprise of numbers, 42A and 32A Haddon, the organisation’s day care services, a hall, a nursery and garden centre, a craft shop, a coffee shop and a bakery. The coffee shop and bakery occupy the corner of the site and this provides occupational opportunities for service users and enables local residents to visit the shop. The centre of Milton Keynes is close by, offering a large shopping centre, cinema, a range of restaurants and recreational activities, cycle tracks and many other attractions. Service users are encouraged and supported to use public transport to which they have access. Fees range from £18000 to £39000 per year. Care Homes for Adults (18-65 years) Page 5 of 31 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 31 How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection was conducted over the course of a day and covered all the key National Minimum Standards for younger adults. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion. Information received by the Commission since the last inspection was also taken into account. No comment cards were received from people who use the service by the time the report was written. The inspection officer was Barbara Mulligan. The registered manager is Elaine Forbes. The inspection consisted of discussion with the registered manager and other staff, opportunities to meet with some service users, examination of some of the homes required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity.
Care Homes for Adults (18-65 years) Page 7 of 31 Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and service users are thanked for their cooperation and hospitality during this unannounced visit. What the care home does well The flats are a nice and comfortable place to live. People who want to live at Great Holm have their needs assessed before they move in, to make sure the staff can meet the needs of the people who live there. The care plans tell the staff how to care for the people living in the flats. The staff makes sure that the people who live in the flats are safe when they go out and take part in activities. Care Homes for Adults (18-65 years) Page 8 of 31 The people who live in the flats are good friends. The service provides good healthy meals for all the people who live there. People who live at Great Holm are helped to visit the Drs and other health care staff. The evidence seen and comments received indicate that this service meets the diverse needs [e.g. religious, racial, cultural, disability] of individuals within the limits of its Statement of Purpose. What has got better from the last inspection Complaints are being stored in a more secure way and organised better in the complaints book. Improvement has been made to
Care Homes for Adults (18-65 years) Page 9 of 31 some of the flats to provide more pleasant surroundings for service users. FIRE All doors now have door guards to make sure people who live in the flats can be safe if there is a fire. Staff working in the unit have received up to date training. What the care home could do better This inspection shows 1 thing needs to be done to make it okay. There have been on-going problems with staff shortages. The organisation must complete a full review of the needs of people using the service and the staffing levels must be adjusted in line with this assessment. This is to make sure
Care Homes for Adults (18-65 years) Page 10 of 31 that all the needs of people living at Great Holm can be met. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Barbara Mulligan 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 11 of 31 Details of our findings
Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 31 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service .
. People who use the service have their needs thoroughly assessed prior to admission ensuring that staff are prepared for admission, and given opportunity to visit the home beforehand to ensure it meets their needs. Evidence: There have been no new admissions to the service since the previous inspection according to information supplied prior to the inspection. Records relating to the most recently admitted service user were examined and found to be in good order with a detailed and comprehensive needs assessment which indicates that the service user had been involved in the process. The home does not take emergency admissions and is not registered to provide intermediate care. Care Homes for Adults (18-65 years) Page 13 of 31 Individual needs and choices
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. Effective and detailed care plans are in place which adequately document service users needs and how these are to be met, within a risk assessment framework. Evidence: The care of four people using the service was case tracked and their care plans were examined. Each file contains various care planning tools. For example in each file there is an Essential Lifestyle Plan which is the corporate care plan tool, an intimate care policy, a my health document and a Person Centred Plan. In each file seen there is a communications profile which provides staff with information they need, and aids to be used for each individual to help improve communication. The care plans examined by the inspector were in good order, provide specific guidance for staff to follow and are detailed and informative. Files provide lots of examples of people being supported to be as independent as possible, such as accessing facilities in the community, using transport and cooking. Although there is evidence of an annual review for each person, the different tools do not evidence this. For example the intimate care policy for one person was dated
Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: 20/12/2002 and a health care plan for another person was not dated or signed. All records should be signed and dated and this needs to be addressed. Photographs of the individual are placed at the front of their files with information on their history. Copies of local authority community care plans and purchase orders were seen to be in place. Evidence of annual reviews are maintained in each file. Reviews have been improved and take the form of a power point presentation. Copies of photos and pictures are included in the presentation and these are to be commended. Person centered plan folders are kept in service users rooms and those seen reflect individual’s current situation and goals for the future. Daily notes contain good details about how the service user has spent their day. However many entries are difficult to read and it is strongly recommended that all handwritten entries are recorded legibly. Service User consultation through flat meetings enables service users to advocate for themselves, and make decisions about items they may like for their flat, and address any issues they may have with each other. Minutes are kept of these and demonstrate that issues raised are managed appropriately. Records show that service users interests are taken into account when organising activities for them, whether as part of the day service provision or when at home. There are three way meetings held with the person using the service, their link worker and the day services. There are also link worker meetings and the minutes of these are kept in individual’s files. In addition there is a fortnightly peoples forum which takes place fortnightly and is facilitated by an independent person. This is open to all MacIntyre Care service users at the Great Holm site and the inspector was informed that this is well attended. However, the registered manager said that this may be discontinued in the near future. The organisation should ensure that there remains in place a system for service users to be provided with information about the service and an opportunity to give feedback. People who use the service were seen to make decisions during the inspection, such as what to make for lunch, what to purchase at the shop, arranging leisure activities and going to see family at the weekend. Money is well managed for people who live at Great Holm. There are individual wallets kept secure and transaction sheets to record expenditure. Receipts are in place to verify purchases. Reports of the providers monitoring visits show that service users money is checked routinely as part of the visit, which is a good practice. Service users files provide lots of examples of people being supported to be as independent as possible and risk assessments are in place for managing medication, accessing facilities in the community and using public transport. Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. People who use the service have a varied and active lifestyle, which reflects their interests, and are supported to maintain family links and friendships inside and outside the home. Menus are developed by people who use the service with support from care staff, which promotes independence and choice. Evidence: People who use the service are involved in a number of activities, mainly locally based at Great Holm, where there is a coffee shop, a craft shop and a nursery. On site there are opportunities for individuals to take part in craft, drama and computer classes. There is also opportunity for those that wish, to develop office skills and undertake a National Vocational Qualification working at the providers central headquarters. Records show that service users interests are taken into account when organising activities for them, whether as part of the day service provision or when at home. Some people who use the service go to college to learn social skills and life skills. This
Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: may include literacy skills, money management, sex education, People who use the service choose where they would like to go on holidays and staff provide support from planning a holiday to participating in one. Individuals are supported to access the service user fund for items such as holidays if their own funds are low. Service users are encouraged to participate in community events and use the local facilities, as part of integration into the community. Examples include the gym and local leisure centre, the cinema, shops, library, health centre and local pubs and restaurants. Service users were seen to have keys to their doors and had freedom to be alone in their rooms or in the communal areas. In discussions with people who use the service it is apparent that there are no restrictions about family and friends visiting. In one flat visited the residents were home having lunch and they told the inspector that they have a mobile phone to call family and friends and one person was going home to visit family at the weekend. On the day of the visit one staff member was supporting a service user to use public transport to visit family. In each flat visited there were menus drawn up by service users, and individual needs such as vegetarian meals, were being met. The inspector spoke to a small group who were at home having lunch. One person was enjoying a vegetarian diet and another person told the inspector that they have their own fridge as they like to keep their own foods separate. Monthly weights are recorded in a separate book and nutritional screening is evident in files. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. People who use the service have their personal and healthcare needs outlined within their individual plans, ensuring that the manner in which they are supported and cared for by staff is appropriate and promotes their preferences Evidence: Information regarding personal care is recorded in the Essential Lifestyle Plans. People who use the service are supported to choose when they like to go to bed, have a bath, have their meals and take part in other activities. Care plans set out in detail peoples preferred routines, likes and dislikes and partnerships with families and friends. People spoken to on the day of the visit talked about visiting family and how staff support them to do this. Staff spoken to on the day said that personal care is generally flexible and in line with service users needs. For example, where individuals need to go to work they are supported to carry out personal care that ensures they attend work at the appropriate times. This is well documented in care plans. There is good evidence of health care screening in care plans. People who use the service are able to choose their own GP and there is evidence on file of the healthcare support available to individuals. It is clear that routine appointments are attended in line with NHS entitlements and on the day of the visit one service user was being
Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: supported to attend a healthcare appointment. In one care plan looked at there is good information about the needs of an individual who has epilepsy and this provides specific details for staff to follow. There are guidelines in place for each person about their medicines, what they are for, why they are being taken and side effects. The review notes for one individual records that relatives were concerned that the person using the service had not attended an opticians appointment because they had refused to go. The care plan does not demonstrate how this will be resolved. Staff in the review said they are struggling to meet the needs of this person and extra staffing hours are needed. Staffing is assessed further under standard 33. Each person has a completed my health care plan in place. This is detailed and comprehensive. However two of these were not signed or dated and it is recommended that all records are signed and dated. There are appointment sheets in place that detail any healthcare appointments attended and the outcome of the appointments. People who use the service receive additional support through the Learning Disabilities Community Team, where they can access physiotherapists, occupational therapists, speech therapists and other specialist services they may require. Staff provide support to individuals needing to attend outpatient and other appointments. The unit operates a link worker system. However, the rota shows that at the time of the visit there are staffing shortages and seven people who use the service do not have a link worker. Staffing levels are discussed further under standard 33. Several service users have chosen to self-administer their own medication, with support from care staff. There are risk assessments in place for this and these are up to date and signed by the author. The unit uses a Monitored Dosage System (MDS). The supplying pharmacist has visited to advice on storage, records and safe practices. There were no out of date medications held in the flats of people using the service and there is a returns procedure in place. Each individual has a medication profile and these were examined. These include an assessment of managing medication and homely remedies and consent to medication. The inspector examined medication records and it is pleasing to see that there were no omissions noted. Staff training has been via the supplying pharmacist and training records demonstrate this. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. Procedures for managing complaints and adult protection are in place that ensures that service users or their representatives are listened to and people who use the service are protected from abuse and harm and their rights to be safe are protected. Evidence: Following the previous inspection it was identified that the complaints procedure needed some revision as although produced in 2003 it referred to out of date legislation; the Registered Home Act of 1984; and was not explicit in informing complainants that the Commission may be approached directly. A requirement was issued for a revised complaints procedure to be produced, (with reference to current legislation if legislation is referred to) including the name, address and telephone number of the Commission. This has not been updated and the organisation needs to address this. There is a separate complaints procedure in place for service users. This complaints procedure does not refer to any out of date legislation and does refer the complainant to the Commission. This procedure should be included in the Service Users Guide as the only information that this document contains about complaints is names and addresses of people who the complainant can complain to. This is recommended. The homes complaints log shows that the home has not received any complaints since the last inspection. At the previous inspection the complaints log was not well arranged, with pieces of paper stapled to handwritten pages and some information contained within envelopes which was also stapled to pages. There was also confidential material (relating to a service user at another home) from a strategy
Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: meeting stapled into the complaints log, which was freely accessible in the office. A recommendation was made to manage records of complaints in a more orderly manner and a requirement was issued to keep confidential information secure. This has been complied with and the complaints log was well organised and a separate folder that contains confidential information was kept separately in a lockable filing cabinet. The Commission has not received any complaints about this service. During the previous inspection it was identified that the organisations adult protection procedures referred to out of date legislation and referred staff to the registering authority. A requirement was issued for the adult protection policy to be updated to reflect current legislation (if legislation is referred to) and to make explicit to staff that they are to report adult protection matters to the Commission. This has not been updated and the organisation must address this. The home has the Milton Keynes Safeguarding policy and the registered manager said that she refers to this. There has been one safeguarding referral according to information supplied before the inspection. Training records show that care staff have received up to training in safeguarding vulnerable adults. Care Homes for Adults (18-65 years) Page 21 of 31 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. A comfortable and homely environment has been created for people who use the service, ensuring that they have appropriate surroundings in which to live. However further attention is needed to the cleaning of the flats to ensure the flats are maintained in a hygienic manner. Evidence: The service consists of five flats, numbered 44 to 52 Haddon in Great Holm. Four of the flats provide accommodation for small groups of service user’s; the fifth is for single occupancy. The staff office is separate to the flats although very close by. From Great Holm, service users have good access to the facilities within Milton Keynes city centre and there are good transport links. Three of the six flats were toured as part of this visit and people who live in the flats were asked permission by staff for entry. Many people who use the service were out at work on the day of the inspection. Two people offered to show their room to the inspector. These were decorated in a style that demonstrates the individuals interests and preferences. There were three requirements issued at the previous report regarding improvements to the environment. These were: Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: 1) Bedrooms doors are not to be held open by door wedges or other items. Only devices approved by the fire officer may be safely used. 2) Suitable storage facilities are to be provided for the use of service users. 3) Service users are to be provided with extra support to carry out in depth cleaning of their flats. All bedroom doors have now been fitted with door guards and in the three flats seen doors were not being additionally held open with other objects. The issue regarding a lack of storage space has been resolved. The unit has purchased loft ladders so these can be used as storage areas. During a tour of the premises it was noted that the flats are being maintained at a reasonable and hygienic standard. Most parts of the flats that were seen were in good order but some attention to deeper cleaning is needed, for example, several toilets were badly stained and in the review notes for one individual, the parents were concerned about the cleanliness of their relatives room and the flat. Present staffing levels do not allow for staff to spend an appropriate amount of time supporting service users to undertake this as needed and this must be addressed by the organisation. Staffing levels are discussed further under standard 33. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. Training and recruitment procedures ensure Service users benefit from a team who have the right skills and competencies to support the people who live at the service. However, staffing levels need an urgent review to ensure there are sufficient numbers of staff to meet the service users needs. Evidence: The home has a small group of staff providing support and care to service users. The AQAA returned to us in June tells us that six staff have completed NVQ training. However on the day of the visit there were only five permanent staff and one trainee. Three staff have left the service in the past twelve months and on the day of the visit the inspector was informed that a further staff member was due to change from a permanent position to a relief position. This is a significant turnover of staff for a small team. The home has continued to notify the Commission when staffing levels had dropped to one carer working part of a shift to fourteen service users, either due to people ringing in sick or needing to take service users to hospital. Whilst service users personal care needs are low they require supervision at the peak times when these levels dropped and some degree of risk may have been present at these times. At the previous inspection there have been on-going difficulties experienced by the unit and a recommendation was made following the previous inspection that serious consideration is to be given to increasing the staffing ratios in the unit, to allow staff to fully meet
Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: the needs of service users. It was difficult to see, given that the day of the inspection was not an exceptional day, how staff could sustain working with just two people on duty, plus working in a cramped office with poor natural light and little ventilation. It was noted that the manager was having to keywork service users, which would be detracting from time more usefully spent managing the service. There has been no improvement in this area, but does appear to be less satisfactory than assessed at the previous inspection. As already mentioned in the report, difficulties are being experienced supporting service users with cleaning, key working and staffing the unit appropriately. On the day of the inspection, one staff member was supporting a service user to visit their family and the remaining staff member on duty was a relief staff member who supported a service user to attend a health care appointment. This left no staff available in the unit. However there was one individual who was at home in her flat due to a recent injury. Staffing levels must be addressed as a matter of urgency and the organisation is required to undertake a review of service users needs and the staffing levels needed to fully meet the needs of all service users living at 52A Haddon. It is noted that the organisation has a formal agreement with the Commission for it to hold centrally some specific staff recruitment documentation and maintain a signed checklist within the home. Files held centrally were assessed at the previous inspection and were assessed as standard met. At the previous inspection it was identified that training records were incomplete and copies of certificates from courses attended had not been collated for each person working at the service. Training records were looked at during this visit and were found to be much improved. Copies of certificates from courses attended have been collated for each person working at the service. These demonstrate that all staff are up to date with basic food hygiene training, first aid training and Moving and Handling training. There is evidence of further training, which includes positive approaches in supporting people whose behaviour challenges, effective appraisals, the mental capacity act and nutrition and health. At the previous inspection a requirement was issued for The Commission to be provided with details of all relief staff employed, line managers and confirmation that necessary training, formal staff supervision and annual appraisals are being completed. This has been received by the Commission and the registered manager said that this has also been discussed at head of service meetings. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service
. The home has implemented a quality assurance system but this should be strengthened and delivered more consistently to ensure the unit is being proactive in identifying issues that may affect the well being of people who use the service. The service has a registered manager, ensuring continuity of care, and there are systems in place within the home that are used to ensure that health, safety and welfare of the people who use the service are protected and promoted. Evidence: The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. She has attained National Vocational Qualification level 4; her post comes with a job description outlining duties and responsibilities. The registered manager reports to an external line manager who carries out her supervision monthly and undertakes monitoring visits on behalf of the provider. Examples of further training in the past twelve months include, investigations and disciplinaries, along with performance problems in your team, emergency first aid, effective appraisals and a health and safety update. The registered manager said that service satisfaction questionnaires were sent out in
Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: 2007 but there does not appear to be any feedback from this exercise. At the previous visit it was identified that following the last set of questionnaires that were sent out no findings had not been collated into a report, which leaves the exercise open ended. The inspector recorded in the previous report that should a further exercise be carried out it would be expected that a registered manager would collate the findings as part of their professional role and share these with the people who took part and relevant parties. This has not taken place again and it is questionable whether this exercise has any benefit and how the service can measure its success in achieving its aims and objectives and statement of purpose The quality assurance systems appears to be a paper exercise only and the process needs to be strengthened. This is strongly recommended. Monthly monitoring reports were looked at for the past five months and they follow a detailed format that shows speaking with staff and people who use the service is a regular feature of the visits, plus good practices such as examining a sample of individuals money and staff training records. There is a forum that is held twice a week and is facilitated by an independent person. This is open to all people who us the MacIntyre services at the Great Holm site. Flat meetings and link worker meetings take place on a regular basis and minutes are kept of these, which were observed at the inspection. A range of health and safety checks are in place at the service and carried out on a daily, weekly or monthly basis. Fire safety records show that the fire risk assessment is fully completed and dated 22/08/2007. There are service user emergency plans in place in the event of fire. Records show that fire training for staff is up to date. The fire alarm system is tested weekly and there fire equipment was last serviced on 28/07/2008. Following the previous inspection a requirement was issued for evidence to be provided that the works required from the previous fire authority have been carried out. This has been complied with and the inspector observed an invoice dated 10/05/07 for works completed and also observed the repairs during this visit. There is written evidence of water and fridge and freezer temperatures. There are service certificates available for PAT testing, electrical installation and gas appliances. Following the previous inspection a requirement was issued for care staff to attend and update all mandatory training as necessary. Training records examined on the day of the inspection show that staff have received this. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes
x No Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No Standard Regulation Requirement Timescale for action 1 22 22 A revised complaints procedure is to be produced (with reference to current legislation if legislation is referred to) including the name, address and telephone number of the Commission. 01/11/2007 2 23 13(6) The adult protection policy is 01/11/2007 to be updated to reflect current legislation (if legislation is referred to) and to make explicit to staff that they are to report adult protection matters to the Commission. Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set
No Standard Regulation Description Timescale for action 1 33 18 The registered person is 30/11/2008 required to ensure that a full assessment of service users needs is completed and staffing levels are reviewed in line with this assessment. To ensure there are sufficient staffing numbers to support service users assessed needs at all times. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 2 3 7 19 22 It is recommended that all handwritten entries are recorded legibly. It is recommended that all records are signed and dated by the person completing them. It is recommended that a copy of the complaints procedure is included on the Service Users Guide. Care Homes for Adults (18-65 years) Page 29 of 31 4 39 It is strongly recommended that the home strengthens their quality assurance systems to ensure the unit is being proactive in identifying issues that may effect the well being of people who use the service. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website.
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